# Fluoxetine and Thrombocytopenia in Bipolar Disorder: Unveiling a Rare Adverse Effect

## TL;DR

A rare case of fluoxetine causing severe low platelet count in a bipolar disorder patient is reported, highlighting the need for vigilance.

## Contribution

Identifies fluoxetine as a potential cause of thrombocytopenia in patients with bipolar disorder.

## Key findings

- A 26-year-old patient's platelet count dropped to 34 × 10³/µL during fluoxetine treatment.
- Discontinuation of fluoxetine led to platelet count improvement.
- Other causes of thrombocytopenia were ruled out in the patient.

## Abstract

Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is widely prescribed to treat depressive episodes but is rarely associated with hematological side effects such as thrombocytopenia. This report presents the case of a 26-year-old Omani man with bipolar disorder and chronic idiopathic thrombocytopenia who developed a significant decline in platelet count while being treated with fluoxetine during a depressive episode.

Thrombocytopenia, defined as a platelet count below 150 × 10³/µL, can result from various factors, including immune dysregulation, infections, or drug-induced effects. Prior to initiating fluoxetine, the patient's platelet levels had been stable. However, it progressively declined during treatment, eventually reaching a critical level of 34 × 10³/µL. Extensive investigations ruled out other causes, implicating fluoxetine as the primary contributor. Discontinuing the medication led to a gradual improvement in the patient's platelet count.

This case underscores the importance of promptly recognizing platelet decline and the need for healthcare providers to remain vigilant about SSRI-induced hematological side effects, especially in patients with pre-existing thrombocytopenia.